title: A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness.
abstract: BACKGROUND
  The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers.
  
  
  METHODS
  We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease.
  
  
  RESULTS
  Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes.
  
  
  CONCLUSIONS
  In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.
authors.affiliation: Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. masoud.mirzaei@sydney.edu.au
authors.forename: Masoud
authors.initials: M
authors.lastname: Mirzaei
authors.forename: Clive
authors.initials: C
authors.lastname: Aspin
authors.forename: Beverley
authors.initials: B
authors.lastname: Essue
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Jeon
authors.forename: Paul
authors.initials: P
authors.lastname: Dugdale
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.forename: Stephen
authors.initials: S
authors.lastname: Leeder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care